| NPI | 1659037836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71011989A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN F10210869) |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2022-10-17 |